| Summary: | The cutaneous manifestations of cytomegalovirus (CMV) vary and may be difficult to identify histopathologically. Cutaneous CMV lesions are relatively rare and may be overlooked as infection usually presents in visceral organs, particularly the respiratory and gastrointestinal tract. Cutaneous manifestations of CMV infection are heterogeneous, with ulceration in the genital area occurring most commonly. This case highlights an unusual pustular presentation of CMV infection to aid in the recognition and diagnosis of cutaneous lesions. We report a 52-yearold male, with a history of chronic lymphocytic leukemia, who presented with multiple, generalized, tender, erythematous, draining papules and nodules in the skin. Histopathology revealed a dense, pustular infiltrate with characteristic cytomegalic inclusions in the deep dermis. This highlights the importance of considering CMV infection in the differential diagnosis of pustulonodular skin lesions, particularly in immunocompromised patients.
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